Remote Medical Case Manager & Care Navigator

Highmark Health Company

Delaware

Hybrid

USD 73,000 - 117,000

Full time

6 days ago

Be an early applicant

A complete application in a minute

Tailored resume and cover letter, ready to send.

Get past ATS filters

Job summary

Highmark Inc. is seeking a full-time Case Manager to provide comprehensive case management services to members within the Delaware region.

The role involves assessing needs, developing care plans, coordinating services, and monitoring progress to deliver quality, cost-effective care that aligns with contract benefits. The position requires 3 years of relevant experience (or 5 years with a Bachelor’s in Social Work), RN licensure or a Master’s in SW, and the ability to work with diverse

Qualifications

3 years of experience in clinical, case/utilization management, and/or disease condition management or provider operations/health insurance with RN licensure or a Master’s degree
5 years’ experience with a Bachelor’s in Social Work preferred
Pediatric experience preferred
Medicaid/Medicare experience a plus
Experience serving diverse populations with cultural competency

Responsibilities

Manage a caseload of members with moderate complexity health needs.
Assess members’ health status, needs, and resources.
Develop individualized care plans with members, physicians, and other providers.
Coordinate referrals to specialists and community resources.
Monitor member progress toward goals and adjust care plans as needed.
Document all activities in compliance with policies and regulations.